Tag: risk assessment

Bioethics Blogs

Don’t Feed the Trolls: Bold Climate Action in a New, Golden Age of Denialism

by Marcus Hedahl and Travis N. Rieder

ABSTRACT. In trying to motivate climate action, many of those concerned about altering the status quo focus on trying to convince climate deniers of the error of their ways. In the wake of the  2016 Election, one might believe that now, more than ever, it is tremendously important to convince those who deny the reality of climate science of the well-established facts. We argue, however, that the time has come to revisit this line of reasoning.  With a significant majority of voters supporting taxing or regulating greenhouse gases, those who want to spur climate action ought to focus instead on getting a critical mass of climate believers to be appropriately alarmed. Doing so, we contend, may prove more useful in creating the political will necessary to spur bold climate action than would engaging directly with climate deniers.

Less than a month after the 2016 presidential election, incoming White House Chief of Staff Reince Priebus stated that climate change denialism would be the “default position” of the Trump administration (Meyjes 2016). In March 2017, Scott Pruit, President Trump’s choice to lead the Environmental Protection Agency, expressed his belief—contrary to the estabilished scientific consensus—that carbon dioxide was not one of the primary contributors of climate change (Davenport 2107). Given this existence of climate denialism at the highest reaches of U.S. government, one might believe that, now more than ever, it is tremendously important to convince those who deny the reality of climate science of the well-established facts.[1] Surely, with truth on our side, we must trumpet the evidence, making deniers our primary target and acceptance of the truth of climate change our primary goal.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

Bioethics Blogs

Using AI to Predict Criminal Offending: What Makes it ‘Accurate’, and What Makes it ‘Ethical’.

Jonathan Pugh

Tom Douglas

 

The Durham Police Force plans to use an artificial intelligence system to inform decisions about whether or not to keep a suspect in custody.

Developed using data collected by the Force, The Harm Assessment Risk Tool (HART) has already undergone a 2 year trial period to monitor the accuracy of the tool. Over the trial period, predictions of low risk were accurate 98% of the time, whilst predictions of high risk were accurate 88% of the time, according to media reports. Whilst HART was not so far been used to inform custody sergeants’ decisions during this trial period, the police force now plans to take the system live.

Given the high stakes involved in the criminal justice system, and the way in which artificial intelligence is beginning to surpass human decision-making capabilities in a wide array of contexts, it is unsurprising that criminal justice authorities have sought to harness AI. However, the use of algorithmic decision-making in this context also raises ethical issues. In particular, some have been concerned about the potentially discriminatory nature of the algorithms employed by criminal justice authorities.

These issues are not new. In the past, offender risk assessment often relied heavily on psychiatrists’ judgements. However, partly due to concerns about inconsistency and poor accuracy, criminal justice authorities now already use algorithmic risk assessment tools. Based on studies of the past offenders, these tools use forensic history, mental health diagnoses, demographic variables and other factors to produce a statistical assessment of re-offending risk.

Beyond concerns about discrimination, algorithmic risk assessment tools raise a wide range of ethical questions, as we have discussed with colleagues in the linked paper.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

Bioethics Blogs

Controlling Direct Access to Personal Health Information

By Sarah Duranske

In 1978, for the first time, an American woman could take a pregnancy test in the comfort of her own home. Critics claimed that home pregnancy tests only would be used by promiscuous or immoral women who were too ashamed to visit their doctors, but the appeal to women was undeniable. [1] Today, eight out of ten women learn they are pregnant from a home pregnancy test.[2]

In the 1980s, as the AIDS crisis swept the nation, the FDA banned the use of at-home AIDS tests over fears of poor test reliability and insufficient counseling.[3] Advocacy groups bolstered these fears by highlighting the suicide of a man who jumped off the Golden Gate Bridge after testing positive for HIV.[4]  But with improvements in testing technology and treatment options – and stymied by a stubbornly high infection rate – the FDA reversed its stance.  It encouraged home test kit applications in 1990 and approved two home collection kits in 1996.[5]  Within a year, more than 175,000 people purchased kits, and the expanded screening was not associated with any increase in the suicide rate.[6]

In 2013, the FDA shut down 23andMe’s health-related genetic tests due to concerns that users would act, or fail to act, to their detriment based on incorrect test results or unsupported clinical interpretations. In spite of experts’ concerns, 23andMe had genotyped around 400,000 individuals between its 2007 market entrance and the FDA’s 2013 action.[7] Studies consistently demonstrate (for better or worse) that people don’t change their behavior based on genetic tests that report on disease risk.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

Bioethics Blogs

Balancing Costs and Benefits: A Clinical Perspective Does not Support a Harm Minimization Approach for Self-injury Outside of Community Settings

Guest Post: Hanna Pickard and Steve Pearce

Responding to: Harm may sometimes be a good thing? Patrick Sullivan

Sullivan’s emphasis on the importance of supporting autonomy and independence among vulnerable people who self-injure is fundamental to good clinical practice. This is why some forms of harm minimization, such as encouraging reflection, responsibility, safe cutting and where appropriate self-aftercare, are uncontroversial and already widely practiced within community settings. The situation is different, however, with respect to both secure and non-secure inpatient settings. It is also different when we consider the other forms of harm minimization that Sullivan advocates, namely, the provision of self-harming instruments on wards alongside education about anatomy.

In secure (forensic) inpatient settings, it is neither practical nor ethical to provide implements that can be used as weapons to any patient, for any reason. This would be to severely compromise staff and patient safety.

In non-secure inpatient settings, patients are likely to be detained under the Mental Health Act. This raises the question of the grounds of detention. Typically, patients who self-injure are detained because they are judged to be currently at risk of life-endangering or life-changing injury. As Sullivan notes, it is not clinically or ethically appropriate to provide patients with the means to self-injure when they are in this state of mind. This means that the relevant inpatient population for which a harm minimization approach could even be considered is relatively small: those who have a standing pattern of self-injury and who are detained on non-secure units for reasons other than acute self-injury.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

Bioethics Blogs

They Can’t Say No: Ebola & Quarantined Soldiers

Sheena M. Eagan Chamberlin calls attention to the limited autonomy of military personnel regarding mandatory quarantine following the Ebola crisis.

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In March 2016, The World Health Organization terminated its public health emergency warning for Ebola. We can now reflect upon this epidemic with particular attention to the ways in which we could improve our response to future public health crises.

From 2014-2016 West Africa experienced the largest outbreak of Ebola in history. There were over 28,000 cases of Ebola, and 11,325 people left dead. Many governmental and non-governmental organizations responded to this public health emergency. As well, the international military community provided a significant amount of logistical support in West Africa.

Numerous ethical challenges were faced by those who responded to the Ebola epidemic. Among the most complex challenges were those related to quarantine policies. Due to the novel and deadly nature of the virus, many people (including patients, healthcare workers, and logistic support workers) were quarantined for periods of time throughout the epidemic. Policies concerning quarantine varied from place to place. In some cases, exposed individuals were under mandatory ‘self-quarantine,’ and in other cases, large groups of low-risk and unexposed people were quarantined.

In the United States, in a civilian context, the forced quarantine of returning health care workers met with criticism and condemnation. Many argued that public health interventions should not overtly infringe on personal freedom without adequate justification. In the case of Ebola, the mode of infection was known, as were the signs, symptoms and incubation period. Public health professionals determined that active-direct monitoring was sufficient.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

Bioethics Blogs

Insuring for Climate Change

Vanessa Lam considers how the federal government might respond to climate change.

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The devastating floods of 2016 in Sydney and of 2013 in Calgary and in the Greater Toronto Area highlight the risks of climate change in Canada. Since climate change is expected to result in more frequent floods of greater severity, the federal government has an interest in finding sustainable options for overland flood disaster recovery.

At present, the Government of Canada spends increasing amounts of taxpayers’ money on flood recovery efforts through Disaster Financial Assistance Arrangements. This financial assistance is an important resource for provinces recovering from natural disasters. However, this spending is becoming problematic. Canada’s Parliamentary Budget Officer has reported that flood recovery represented 75% of Disaster Financial Assistance Arrangements spending and cited a lack of overland flood insurance for property owners among the causes of this expense. Since property owners do not have overland flood insurance, Disaster Financial Assistance Arrangements cover expenses that might otherwise be covered by insurance, including the repair and restoration of primary residences and small businesses.

Overland flood insurance was not available in Canada until 2015, when a single insurance company offered coverage for freshwater, but not saltwater, overflows. Insurance companies are hesitant to offer overland flood insurance because overland flooding traditionally affects a fraction of the Canadian population. Since the demand for overland flood insurance is low and purchasers presumably live in areas more prone to flooding, insurance premiums would be unaffordable as the risk is not spread across a large enough population of persons paying insurance premiums.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

Bioethics Blogs

Pregnancy, stigma, and moral responsibility in the Zika epidemic

by Kelly McBride Folkers, BS

Pregnancy comes with great moral responsibility from mother to future child. A healthy pregnancy requires that pregnant women abstain from certain behaviors, like eating unpasteurized foods and drinking excessive amounts of alcohol. These decisions affect the wellbeing of the future child. But in addition to bearing the responsibility for the healthy development of the woman’s individual child, pregnant women face social stigmatization during pregnancy. The world takes notice of pregnant women, and this attention can be as innocuous as offering a seat to a visibly pregnant woman on the subway. But it all too often results in social isolation, decreased physical activity, and when pregnant women report a lack of social support, higher incidence of depression and anxiety symptoms.

The scientific and public health communities are learning that the Zika virus is capable of more damage to the developing fetus than initially thought possible. I am researching the ethical implications of Zika’s impact on reproductive health decisions for my master’s thesis and co-wrote a public health guide on staying healthy while traveling to areas with active Zika transmission. As a result of my work, I am left with a fear that pregnant women bear not only a responsibility to their own health and that of their future child, but a social one that is wrongfully imposed upon them by public health officials to make the rest of us feel comfortable.

The social norms around pregnancy are unlikely to change, yet I empathize with the added stressors to pregnant women in Florida as Zika continues to spread in the United States.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

Bioethics Blogs

1000 Risks and Birth-and-Death in Cape Town by Kathleen McDougall

“I was willing to die,” Terri told me, “I just didn’t want to have another caesarian.” She referred to her vaginal birth after three c-sections (a VBA3C), which took place at home, since no Cape Town hospital would allow her what is termed a trial of labour – an attempt at vaginal birth – for fear of uterine rupture. It is widely agreed that the risks for planned VBACs are far less than that of planned repeat c-sections (RCOG 2015; Curtin et al 2013). Yet, all the obstetricians that Terri consulted in this pregnancy and the last two (in both the public and private healthcare sectors) preferred planned c-section risks to the risk of uterine rupture. One doctor told her that waiting for spontaneous onset labour was like running blindfolded across a busy freeway. Terri came to disagree profoundly with the doctor’s risk assessment. Now, most medical caregivers agree that the risks are far higher for VBACs taking place at home, not because there is a greater risk of uterine rupture at home, but because in that extremely rare case it may take too long to reach an operating theater. However, Terri could not find a hospital that was willing to support her attempt at a VBA3C. In addition, at a previous attempt at a VBAC in a private hospital, Terri was only allowed to labour for seven hours before being told she must have a repeat c-section. This time, with her husband’s wholehearted support, she prepared carefully for home birth, where she would have more control.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

Bioethics Blogs

Web Roundup: Data, Safety, and Bias by Lily Shapiro

Many people probably saw the news that Facebook allegedly privileges left-leaning stories in its trending news section, a story broken by Gizmodo at the beginning of this month. The BBC builds on this report to explore how what we see online (and the various ways in which this get tailored more and more specifically to us) affects our behavior. “[I]t is worth remembering that the designers of the technology we use have different goals to our own – and that, whether our intercessor is an algorithm or an editor, navigating it successfully means losing the pretense that there’s any escape from human bias.”

In a long article in The Verge, authors Catherine Buni and Soraya Chemaly detail the hidden world of content moderation on the Internet. They outline a history of moderation, and the levels of seriousness with which which various content hosts approach moderation (Pinterest versus Reddit versus Facebook, etc), raising questions along the way about the role of moderation in politics (when does the newsworthiness of a video depicting violence outweigh general guidelines prohibiting violence, what role do moderators play, wittingly or no, in social and political movements), free speech and the legal implications and histories of moderation, the unpaid and unrecognized labor that users themselves do to moderate content, and the undervaluing and off-shoring of the very grueling and mentally taxing work of moderation. The Secret Rules of The Internet

The Guardian has an article about the secrecy of research about online harassment and bullying, in which the author argues that Victorian social movements for food safety can teach us something about how to make the Internet a safer place for everyone, while acknowledging the that, “The underlying causes of online harassment can’t be solved by detecting and banning a few toxic commenters.”

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

Bioethics Blogs

Technologies of Care: Administering Donated Breast Milk in a South African Neonatal Intensive Care Unit by Miriam Waltz

This is the third installment of the series from the University of Cape Town’s First Thousand Day Research Group. My research traces out the pathways of donated milk from donor to recipient in a state neonatal unit in South Africa (Waltz 2015), to show how care and technologies are interwoven in complex and sometimes surprising ways.

Breastfeeding is widely seen as the best infant feeding option for mother and baby. The dominant discourse in both the public and the medical realm presents breastfeeding as a natural behaviour, best for babies, best for mums. In a recent series, The Lancet claims that increasing breastfeeding worldwide could prevent over 800,000 child deaths every year (Victora et al. 2016). This position is reflected in state policy and official declarations of the World Health Organisation (WHO) and UNICEF. In South Africa, after a decade of promoting the use of formula milk to offset possible vertical (mother to child) HIV transmission, the state re-committed to facilitating breastfeeding in the Tshwane declaration of August 2011 (see also Doherty et al. 2010 for the revised WHO guidelines on breastfeeding). Breast milk is even more important in the case of premature or low birth weight babies, who are highly susceptible to necrotising enterocolitis, (a serious gastrointestinal condition) if fed on formula milk (Neu and Walker 2011). Here, breast milk is critical in securing life; ‘breast is best’ (Murphy 1999). Where the birth mother’s breast milk is not available, donated breast milk is the best alternative.

My research on the milk’s trajectories was wide-ranging. I interviewed donor mothers; members of milk banks associated with the collection, testing, packaging and distribution of donated milk; hospital staff responsible for its prescription and distribution; and mothers whose infants were receiving donated milk.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.